HHS Issues Final Rule to Protect Conscientious Objection

In late January, the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued a final rule that restores and strengthens the processes for handling complaints of discrimination related to conscientious objection.

As defined by the APA Ethics Committee, “In medicine, conscientious objection is the refusal to perform legal, medically appropriate health care because of moral, religious, or other well-considered, deeply held personal beliefs” (see page 8 of the “Opinions of the Ethics Committee on the Principles of Medical Ethics”).

The final rule, titled “Safeguarding the Rights of Conscience as Protected by Federal Statutes,” will go into effect on March 11. It offers updates on the following:

• Clarifies that the Office for Civil Rights has the authority to receive, handle, and investigate complaints related to federal statutes that protect health care entities from discrimination for moral or religious conscientious objection (“Federal health care conscience protection statutes,” all of which are listed in Appendix A to Part 88 of the final rule).

• Describes the tools and processes that the Office for Civil Rights may use to enforce federal health care conscience protection statutes (for example, conducting investigations and initiating compliance reviews).

• Encourages entities to post a notice informing providers and patients of their rights under the federal health care conscience protection statutes.

What Does This Mean for Psychiatrists?

The APA Ethics Committee has issued related guidance that further explores the ethical implications of conscientious objection by answering the question: “If a patient requests a treatment that I am morally opposed to, I understand that I can conscientiously object to providing this care. However, given my conscientious objection, is it also ethical to refuse to refer this patient to a provider who may provide this care?”

In response to this question, the Ethics Committee opined that “conscientious objection must not negatively impact the patient’s health or their access to legal, medically appropriate health care.”

“[I]n situations where the psychiatrist’s moral objection is so deeply held that they decline to refer the patient, they should still ensure that the patient receives unbiased information about how to access further information about the requested treatments” (see page 8 of the “Opinions of the Ethics Committee on the Principles of Medical Ethics”). ■